Hand Hygiene: Why, How & When? WHY? HOW? • Thousands of people die every day • Clean your hands by rubbing them around the world from infections with an alcohol-based formulation, acquired while receiving health care. as the preferred mean for routine hygienic hand antisepsis if hands • Hands are the main pathways of are not visibly soiled. It is faster, germ transmission during health care. more effective, and better tolerated by your hands than washing with • Hand hygiene is therefore the most soap and water. important measure to avoid the transmission of harmful germs • Wash your hands with soap and water and prevent health care-associated when hands are visibly dirty or visibly infections. soiled with blood or other body fluids or after using the toilet. • This brochure explains how and when to practice hand hygiene. • If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of WHO? Clostridium difficile, hand washing with soap and water is the preferred means. • Any health-care worker, caregiver or person involved in direct or indirect patient care needs to be concerned about hand hygiene and should be able to perform it correctly and at the right time. PAGE 1 OF 7 WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members All reasonable precautions have been taken by the World Health Organization to verify the of the Infection Control Programme, for their active participation in developing this material. information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the Revised August 2009 reader. In no event shall the World Health Organization be liable for damages arising from its use. HAND HYGIENE: WHY, HOW & WHEN? HOW TO HANDRUB? RUB HANDS FOR HAND HYGIENE! WASH HANDS WHEN VISIBLY SOILED Duration of the entire procedure: 20-30 seconds 1a 1b 2 Apply a palmful of the product in a cupped hand, covering all surfaces; Rub hands palm to palm; 3 4 5 Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms interlaced fingers and vice versa; with fingers interlocked; 6 7 8 Rotational rubbing of left thumb Rotational rubbing, backwards and Once dry, your hands are safe. clasped in right palm and vice versa; forwards with clasped fingers of right hand in left palm and vice versa; PAGE 2 OF 7 WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members All reasonable precautions have been taken by the World Health Organization to verify the of the Infection Control Programme, for their active participation in developing this material. information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. HAND HYGIENE: WHY, HOW & WHEN? HOW TO HANDWASH? WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB Duration of the entire procedure: 40-60 seconds 0 1 2 Wet hands with water; Apply enough soap to cover Rub hands palm to palm; all hand surfaces; 3 4 5 Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms interlaced fingers and vice versa; with fingers interlocked; 6 7 8 Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water; clasped in right palm and vice versa; forwards with clasped fingers of right hand in left palm and vice versa; 9 10 11 Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe. with a single use towel; Hand care Please remember • Take care of your hands by regularly using a protective • Do not wear artificial fingernails hand cream or lotion, at least daily. or extenders when in direct contact with patients. • Do not routinely wash hands with soap and water immediately before or after using an alcohol-based handrub. • Keep natural nails short. • Do not use hot water to rinse your hands. • After handrubbing or handwashing, let your hands dry completely before putting on gloves. PAGE 3 OF 7 WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members All reasonable precautions have been taken by the World Health Organization to verify the of the Infection Control Programme, for their active participation in developing this material. information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. HAND HYGIENE: WHY, HOW & WHEN? WHEN? YOUR 5 MOMENTS FOR HAND HYGIENE* CRITICAL SITE WITH INFECTIOUS RISK FOR THE PATIENT RE FO /ASEP E AN TIC B LE EDU OC RE C R P 2 BEFORE AFTER TOUCHING TOUCHING 1A PATIENT 4 A PATIENT CRITICAL SITE WITH BODY FLUID Y D E A O R EXPOSURE RISK FT B U 3 ER S F LUI PO R D EX ISK AFTER TOUCHING PATIENT 5 SURROUNDINGS *NOTE: Hand hygiene must be performed in all indications described regardless of whether gloves are used or not. PAGE 4 OF 7 WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members All reasonable precautions have been taken by the World Health Organization to verify the of the Infection Control Programme, for their active participation in developing this material. information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. HAND HYGIENE: WHY, HOW & WHEN? 1 Before touching a patient 4 After touching a patient WHY? To protect the patient against colonization and, in some cases, WHY? To protect you from colonization with patient germs against exogenous infection, by harmful germs carried on your hands and to protect the health-care environment from germ spread WHEN? Clean your hands before touching a patient when WHEN? Clean your hands when leaving the patient’s side, approaching him/her* after having touched the patient * Situations when Moment 1 applies: Situations when Moment 4 applies, if they correspond to the last contact with the patient before leaving him / her: a) Before shaking hands, before stroking a child’s forehead a) After shaking hands, stroking a child’s forehead b) Before assisting a patient in personal care activities: to move, to take a bath, to eat, to get dressed, etc b) After you have assisted the patient in personal care activities: to move, to bath, to eat, to dress, etc c) Before delivering care and other non-invasive treatment: applying oxygen mask, giving a massage c) After delivering care and other non-invasive treatment: changing bed linen as the patient is in, applying oxygen mask, giving a massage c) Before performing a physical non-invasive examination: taking pulse, blood pressure, chest auscultation, recording ECG d) After performing a physical non-invasive examination: taking pulse, blood pressure, chest auscultation, recording ECG 2 Before clean / aseptic procedure After touching patient surroundings WHY? To protect the patient against infection with harmful germs, 5 including his/her own germs, entering his/her body WHY? To protect you from colonization with patient germs that may be present on surfaces / objects in patient surroundings and to protect WHEN? Clean your hands immediately before accessing a critical the health-care environment against germ spread site with infectious risk for the patient (e.g. a mucous membrane, non-intact skin, an invasive medical device)* WHEN? Clean your hands after touching any object or furniture when living the patient surroundings, without having touched the patient* Situations when Moment 2 applies: This Moment 5 applies in the following situations if they correspond a) Before brushing the patient’s teeth, instilling eye drops, performing a digital to the last contact with the patient surroundings, without having vaginal or rectal examination, examining mouth, nose, ear with or without touched the patient: an instrument, inserting a suppository / pessary, suctioning mucous a) After an activity involving physical contact with the patients immediate b) Before dressing a wound with or without instrument, applying ointment environment: changing bed linen with the patient out of the bed, on vesicle, making a percutaneous injection / puncture holding a bed trail, clearing a bedside table c) Before inserting an invasive medical device (nasal cannula, nasogastric b) After a care activity: adjusting perfusion speed, clearing a monitoring alarm tube, endotracheal tube, urinary probe, percutaneous catheter, drainage), disrupting / opening any circuit of an invasive medical device (for food, c) After other contacts with surfaces or inanimate objects (note – ideally medication, draining, suctioning, monitoring purposes) try to avoid these unnecessary activities): leaning against a bed, leaning against a night table / bedside table d) Before preparing food, medications, pharmaceutical products, sterile material 3 After body fluid exposure risk WHY? To protect